The impact of tuberculosis on health utility: a longitudinal cohort study

Bauer, Melissa; Ahmed, Sara; Benedetti, Andrea; Greenaway, Christina; Lalli, Marek; Leavens, Allison; Menzies, Dick; Vadeboncoeur, Claudia; Vissandjée, Bilkis; Wynne, Ashley; Schwartzman, Kevin

doi:10.1007/s11136-014-0858-6

Cited by 14 publications

(24 citation statements)

References 21 publications

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“…This reflected our published data using the standard gamble, among persons treated for active TB in Montreal [24]. Similarly, based on our previous direct measurements, we attributed a QALY decrement of 0.03 to treatment of LTBI [24]; this was in fact identical to the value used by Shepardson et al [25].…”

Section: Methodssupporting

confidence: 85%

“…Similarly, based on our previous direct measurements, we attributed a QALY decrement of 0.03 to treatment of LTBI [24]; this was in fact identical to the value used by Shepardson et al [25]. We did not attribute separate quality weights to adverse drug effects or hospitalisation, since patients both with and without these were included in our previous sample [24]. No quality decrement was associated with untreated LTBI.…”

Section: Methodsmentioning

confidence: 99%

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Revisiting annual screening for latent tuberculosis infection in healthcare workers: a cost-effectiveness analysis

Mullie

Schwartzman

Zwerling

et al. 2017

BMC Med

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BackgroundIn North America, tuberculosis incidence is now very low and risk to healthcare workers has fallen. Indeed, recent cohort data question routine annual tuberculosis screening in this context. We compared the cost-effectiveness of three potential strategies for ongoing screening of North American healthcare workers at risk of exposure. The analysis did not evaluate the cost-effectiveness of screening at hiring, and considered only workers with negative baseline tests.MethodsA decision analysis model simulated a hypothetical cohort of 1000 workers following negative baseline tests, considering duties, tuberculosis exposure, testing and treatment. Two tests were modelled, the tuberculin skin test (TST) and QuantiFERON®-TB-Gold In-Tube (QFT). Three screening strategies were compared: (1) annual screening, where workers were tested yearly; (2) targeted screening, where workers with high-risk duties (e.g. respiratory therapy) were tested yearly and other workers only after recognised exposure; and (3) post exposure-only screening, where all workers were tested only after recognised exposure. Workers with high-risk duties had 1% annual risk of infection, while workers with standard patient care duties had 0.3%. In an alternate higher-risk scenario, the corresponding annual risks of infection were 3% and 1%, respectively. We projected costs, morbidity, quality-adjusted survival and mortality over 20 years after hiring. The analysis used the healthcare system perspective and a 3% annual discount rate.ResultsOver 20 years, annual screening with TST yielded an expected 2.68 active tuberculosis cases/1000 workers, versus 2.83 for targeted screening and 3.03 for post-exposure screening only. In all cases, annual screening was associated with poorer quality-adjusted survival, i.e. lost quality-adjusted life years, compared to targeted or post-exposure screening only. The annual TST screening strategy yielded an incremental cost estimate of $1,717,539 per additional case prevented versus targeted TST screening, which in turn cost an incremental $426,678 per additional case prevented versus post-exposure TST screening only. With the alternate “higher-risk” scenario, the annual TST strategy cost an estimated $426,678 per additional case prevented versus the targeted TST strategy, which cost an estimated $52,552 per additional case prevented versus post-exposure TST screening only. In all cases, QFT was more expensive than TST, with no or limited added benefit. Sensitivity analysis suggested that, even with limited exposure recognition, annual screening was poorly cost-effective.ConclusionsFor most North American healthcare workers, annual tuberculosis screening appears poorly cost-effective. Reconsideration of screening practices is warranted.

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Section: Methodssupporting

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Revisiting annual screening for latent tuberculosis infection in healthcare workers: a cost-effectiveness analysis

Mullie

Schwartzman

Zwerling

et al. 2017

BMC Med

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“…We derived health utility data from a study ( 38 ) in Canada of migrants who reported for postarrival follow-up. We based adjustments due to adverse events or hospitalization on previous studies ( 30 , 33 ).…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of Latent Tuberculosis Infection Screening before Immigration to Low-Incidence Countries

Campbell¹,

Johnston²,

Cook³

et al. 2019

Emerg. Infect. Dis.

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Prospective migrants to countries where the incidence of tuberculosis (TB) is low (low-incidence countries) receive TB screening; however, screening for latent TB infection (LTBI) before immigration is rare. We evaluated the cost-effectiveness of mandated and sponsored preimmigration LTBI screening for migrants to low-incidence countries. We used discrete event simulation to model preimmigration LTBI screening coupled with postarrival follow-up and treatment for those who test positive. Preimmigration interferon-gamma release assay screening and postarrival rifampin treatment was preferred in deterministic analysis. We calculated cost per quality-adjusted life-year gained for migrants from countries with different TB incidences. Our analysis provides evidence of the cost-effectiveness of preimmigration LTBI screening for migrants to low-incidence countries. Coupled with research on sustainability, acceptability, and program implementation, these results can inform policy decisions.

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“…All health state utilities were defined using the SF-6D scores derived from SF-36 responses and were largely informed by a study performed in new migrants to Canada [ 42 – 44 ]. Health state utilities were evaluated for the duration of time in each health state and not subject to fixed duration.…”

Section: Methodsmentioning

confidence: 99%

“…The duration of time in the TB health state varied based on whether a patient was or was not under surveillance, as defined by the time from symptom onset to TB diagnosis reported by Khan et al . [ 4 ] A baseline value of 0.81 was used for all participants without LTBI or TB [ 42 ], with adjustments for other health states, where applicable. Table 1 contains all utility values and adjustments.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of post-landing latent tuberculosis infection control strategies in new migrants to Canada

et al. 2017

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BackgroundThe majority of tuberculosis in migrants to Canada occurs due to reactivation of latent TB infection. Risk of tuberculosis in those with latent tuberculosis infection can be significantly reduced with treatment. Presently, only 2.4% of new migrants are flagged for post-landing surveillance, which may include latent tuberculosis infection screening; no other migrants receive routine latent tuberculosis infection screening. To aid in reducing the tuberculosis burden in new migrants to Canada, we determined the cost-effectiveness of using different latent tuberculosis infection interventions in migrants under post-arrival surveillance and in all new migrants.MethodsA discrete event simulation model was developed that focused on a Canadian permanent resident cohort after arrival in Canada, utilizing a ten-year time horizon, healthcare system perspective, and 1.5% discount rate. Latent tuberculosis infection interventions were evaluated in the population under surveillance (N = 6100) and the total cohort (N = 260,600). In all evaluations, six different screening and treatment combinations were compared to the base case of tuberculin skin test screening followed by isoniazid treatment only in the population under surveillance. Quality adjusted life years, incident tuberculosis cases, and costs were recorded for each intervention and incremental cost-effectiveness ratios were calculated in relation to the base case.ResultsIn the population under surveillance (N = 6100), using an interferon-gamma release assay followed by rifampin was dominant compared to the base case, preventing 4.90 cases of tuberculosis, a 4.9% reduction, adding 4.0 quality adjusted life years, and saving $353,013 over the ensuing ten-years. Latent tuberculosis infection screening in the total population (N = 260,600) was not cost-effective when compared to the base case, however could potentially prevent 21.8% of incident tuberculosis cases.ConclusionsScreening new migrants under surveillance with an interferon-gamma release assay and treating with rifampin is cost saving, but will not significantly impact TB incidence. Universal latent tuberculosis infection screening and treatment is cost-prohibitive. Research into using risk factors to target screening post-landing may provide alternate solutions.

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The impact of tuberculosis on health utility: a longitudinal cohort study

Abstract: Treatment for TB disease had a substantial negative impact on health utility, particularly during the first 2 months of treatment. However, treatment for LTBI did not have a substantial impact.

Cited by 14 publications

References 21 publications

Revisiting annual screening for latent tuberculosis infection in healthcare workers: a cost-effectiveness analysis

Revisiting annual screening for latent tuberculosis infection in healthcare workers: a cost-effectiveness analysis

Cost-effectiveness of Latent Tuberculosis Infection Screening before Immigration to Low-Incidence Countries

Cost-effectiveness of post-landing latent tuberculosis infection control strategies in new migrants to Canada

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